Complications of care in a medical intensive care unit |
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Authors: | Dr Hanna Bloomfield Rubins MD MPH Mark A Moskowitz MD |
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Institution: | (1) the Section of General Internal Medicine and Health Care Research Unit, Evans Memorial Department of Clinical Research and the Department of Medicine, Boston University Medical Center, Boston, Massachusetts;(2) Section of General Internal Medicine, Department of Medicine, Boston VA Medical Center, 150 South Huntington Avenue, 02130 Boston, MA |
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Abstract: | Objective:To determine the frequency and nature of complications of care in the medical intensive care unit (MICU).
Design:Prospective, observational study.
Setting:Seven-bed MICU in a teaching and referral VA hospital.
Patients:295 consecutive patients admitted to the MICU during a ten-month study period.
Interventions:None.
Measurements and main results:Forty-two patients (14%, 95% confidence interval 13%, 16%) experienced one or more complications during their MICU stays.
Compared with other MICU patients, those experiencing complications tended to be older (mean age ± SD: 63.6±10.1 years vs
59.3±14.0 years, p<0.02) and more acutely ill (mean Acute Physiology Score ± SD: 18.3±8.0 vs 12.5±8.0, p=0.0001). These patients
also had significantly longer MICU lengths of stay (mean ± SD: 12.3±14.7 days vs 3.1±4 days, p<0.0001) and higher hospital
mortality rates (67% vs 27%, p<0.001). The 67% mortality rate among patients with complications significantly exceeded the
expected mortality rate of 46% (calculated from the APACHE risk equation).
Conclusion:Complications of care in the MICU are not rare and may independently contribute to in-hospital mortality. The potential for
complications must be recognized when considering ICU care. |
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Keywords: | critical care iatrogenic disease intensive care units |
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